OUTCOME OF PATIENTS REQUIRING MEDICAL ICU ADMISSION FOLLOWING BONE-MARROW TRANSPLANTATION

Despite encouraging results seen following bone marrow transplantation (BMT), it has been observed that once these patients become criticall y ill and require medical intensive care unit (MICU) admission, the ch ances of survival are poor. We hypothesized that while mechanical vent ilation would be an important predictor for death in the MICU, those p atients not requiring mechanical ventilation could be successfully dis charged from the MICU. The records of 36 patients with 43 admissions t o the MICU following BMT were analyzed. Of these admissions, 33 (76.7 percent) patients had allogeneic and 10 (23.3 percent) had autologous transplants, respectively. Overall, 14 (32.6 percent) of the admission s resulted in a satisfactory discharge from the MICU. There was no sig nificant difference in the survival rates between those patients under going allogeneic or autologous transplantations, 11 (33.3 percent) vs 3 (30.0 percent), respectively. Twenty-seven (62.8 percent) of the adm issions resulted in mechanical ventilation and were performed in 20 (6 6.7 percent) patients with allogeneic BMTs and 7 (70.0 percent) patien ts with autologous BMTs, which was not significantly different. The su rvival rate for those requiring mechanical ventilation was significant ly less than for those not mechanically ventilated during their MICU s tay, 1 (3.7 percent) vs 13 (81.3 percent), respectively (p<0.001). Tho se patients who did not survive their MICU stay had a significantly hi gher mean APACHE II score of 21.2 +/- 4.7 than the survivors' score of 15.8 +/- 3.8 (p<0.001). The average length of stay for the survivors was 4.4 +/- 3.0 days, which was significantly less than the 17.8 +/- 2 4.0 days for those patients not surviving (p<0.001). These data indica te that admission to the MICU may result in a beneficial outcome for c ritically ill patients with BMTs, but for those requiring mechanical v entilation due to respiratory failure, the chances of survival are poo r. This information may be useful for providing patients with BMTs and their families with realistic estimates of prognosis prior to transfe r to the MICU and mechanical ventilation.